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1.
PLoS One ; 15(12): e0244087, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33338049

RESUMO

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of direct maternal mortality globally and in Suriname. We aimed to study the prevalence, risk indicators, causes, and management of PPH to identify opportunities for PPH reduction. METHODS: A nationwide retrospective descriptive study of all hospital deliveries in Suriname in 2017 was performed. Logistic regression analysis was applied to identify risk indicators for PPH (≥ 500ml blood loss). Management of severe PPH (blood loss ≥1,000ml or ≥500ml with hypotension or at least three transfusions) was evaluated via a criteria-based audit using the national guideline. RESULTS: In 2017, the prevalence of PPH and severe PPH in Suriname was 9.2% (n = 808/8,747) and 2.5% (n = 220/8,747), respectively. PPH varied from 5.8% to 15.8% across the hospitals. Risk indicators associated with severe PPH included being of African descent (Maroon aOR 2.1[95%CI 1.3-3.3], Creole aOR 1.8[95%CI 1.1-3.0]), multiple pregnancy (aOR 3.4[95%CI 1.7-7.1]), delivery in Hospital D (aOR 2.4[95%CI 1.7-3.4]), cesarean section (aOR 3.9[95%CI 2.9-5.3]), stillbirth (aOR 6.4 [95%CI 3.4-12.2]), preterm birth (aOR 2.1[95%CI 1.3-3.2]), and macrosomia (aOR 2.8 [95%CI 1.5-5.0]). Uterine atony (56.7%, n = 102/180[missing 40]) and retained placenta (19.4%, n = 35/180[missing 40]), were the main causes of severe PPH. A criteria-based audit revealed that women with severe PPH received prophylactic oxytocin in 61.3% (n = 95/155[missing 65]), oxytocin treatment in 68.8% (n = 106/154[missing 66]), and tranexamic acid in 4.9% (n = 5/103[missing 117]). CONCLUSIONS: PPH prevalence and risk indicators in Suriname were similar to international and regional reports. Inconsistent blood loss measurement, varied maternal and perinatal characteristics, and variable guideline adherence contributed to interhospital prevalence variation. PPH reduction in Suriname can be achieved through prevention by practicing active management of the third stage of labor in every birth and considering risk factors, early recognition by objective and consistent blood loss measurement, and prompt treatment by adequate administration of oxytocin and tranexamic acid according to national guidelines.


Assuntos
Parto , Hemorragia Pós-Parto/mortalidade , Nascimento Prematuro/mortalidade , Inércia Uterina/mortalidade , Adulto , Feminino , Humanos , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Nascimento Prematuro/prevenção & controle , Estudos Retrospectivos , Suriname/epidemiologia , Inércia Uterina/prevenção & controle
2.
J Pregnancy ; 2020: 6029160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32695514

RESUMO

Background: Maternal near miss refers to a very ill pregnant or delivered woman who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. Maternal death; the most catastrophic end is frequently described as just "tip of the iceberg," whereas maternal near-miss as the "base." Therefore, this study aimed at assessing the factors associated with maternal near-miss among women admitted in public hospitals of West Arsi zone, Ethiopia. Methods: A facility-based unmatched case-control study was conducted from Mar 1 to Apr 30, 2019. Three hundred twenty-one (80 cases and 241 controls) study participants were involved in the study. Cases were recruited consecutively as they present, whereas controls were selected by systematic sampling method. Cases were women admitted to hospitals during pregnancy, delivery, or within 42 days of termination of pregnancy and fulfilled at least one of the maternal near-miss disease-specific criteria, while controls were women admitted and gave birth by normal vaginal delivery. The interviewer-administered structured questionnaire and data abstraction tool was used to collect data. Data were entered Epi data 3.1 and then transferred into SPSS 20 for analysis. Multivariable logistic regression was used, and the significance level was declared at p value ≤ 0.05. Results: The major maternal near-miss morbidities were severe obstetric hemorrhage (32.5%), pregnancy-induced hypertensive disorders (31.3%), and obstructed labor (26.3%), followed by 6.3% and 3.8% of severe anemia and pregnancy-induced sepsis, respectively. The odds of maternal near miss were statistically significantly associated with women's lack of formal education [AOR = 2.24, 95% CI: (1.17, 4.31)]. Not attending antenatal care [AOR = 3.71, 95% CI: (1.10, 12.76)], having prior history of cesarean section [AOR = 3.53, 95% CI: (1.49, 8.36)], any preexisting chronic medical disorder [AOR = 2.04, 95% CI: (1.11, 3.78)], and having experienced first delay [AOR = 5.74, 95% CI: (2.93, 11.2)]. Conclusions: Maternal education, antenatal care, chronic medical disorders, previous cesarean section, and first delay of obstetric care-seeking were identified as factors associated with maternal near-miss morbidity. Therefore, this finding implies the need to get better with those factors, to preclude severe maternal complications and subsequent maternal mortality.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Anemia/epidemiologia , Anemia/mortalidade , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Educação em Saúde , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/mortalidade , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal , Sepse/epidemiologia , Sepse/mortalidade , Inquéritos e Questionários
3.
PLoS One ; 15(5): e0232983, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32421737

RESUMO

BACKGROUND: Our study aimed to assess the effect of Helping Mothers Survive Bleeding after Birth on knowledge and skills of health workers and whether such effect varies by health workers characteristics. METHODS: Nested in a cluster-randomised trial to assess the effect of the training on health outcomes, we assessed changes in knowledge and simulated skills in 61 facilities. The assessments were done i) before, ii) immediately-after training session and iii) at 10-month follow-up for subset of health-workers of implementation facilities as defined by the trial. We used a self-administered questionnaire and Objective Structures Clinical Examinations to assess three skill sets: Active Management of Third Stage of Labour, removal of retained placenta and management of severe postpartum haemorrhage. We computed summary statistics and used the paired t-test to assess change of knowledge and skills immediately post-training and at 10-month follow-up. Linear regression was done to assess association of scores and health worker characteristics. RESULTS: Of the 636 health workers included, 606 (96.7%) and 591 (91.4%) completed the knowledge and skills assessments, respectively. Majority of the participants (68%) were nurse-midwives. Knowledge scores increased by 15 percentage-points from 77.5% to 93% (95% CI 14.3, 16.3, p-value <0.000), and skills scores by 47 percentage-points (95% CI 46.5, 49.2, p-value <0.000) from 37.5% to 83%. There was a 4.0% decline of skills at 10-month follow-up. The decline was higher in auxiliary staff (-11.8%) and least in nurse-midwives (-2.1%) p-value <0.001. Health workers who assisted less than 5 deliveries in the last month, those who never attended postpartum haemorrhage in-service training and profession experience >8 years were associated with lower mean skill change immediately post-training. CONCLUSION: Our study supports the potential of the Helping Mothers Survive Bleeding after Birth training to increase knowledge and skills of postpartum haemorrhage among all professional groups. Auxiliary staff benefited most from the training but also showed higher skill decline at 10-month. Our study highlights the importance to disaggregate knowledge and skills by health workers characteristics.


Assuntos
Pessoal de Saúde/educação , Capacitação em Serviço , Hemorragia Pós-Parto/terapia , Competência Clínica , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Mão de Obra em Saúde , Humanos , Tocologia/educação , Mães , Avaliação de Resultados em Cuidados de Saúde , Parto , Assistência Perinatal , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/prevenção & controle , Gravidez , Avaliação de Programas e Projetos de Saúde , Inquéritos e Questionários , Tanzânia/epidemiologia
4.
JAAPA ; 33(4): 29-33, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32224823

RESUMO

Postpartum hemorrhage is the leading cause of maternal morbidity and mortality worldwide, and incidence in the United States, although lower than in some resource-limited countries, remains high. Women of color are at a disproportionate risk of developing a life-threatening postpartum hemorrhage. Risk assessment tools are available but because they lack specificity and sensitivity, all pregnant women are considered at risk. Early identification of and intervention in a hemorrhage requires an interdisciplinary team approach to care and can save the lives of thousands of women each year.


Assuntos
Hemorragia Pós-Parto , Diagnóstico Precoce , Feminino , Humanos , Mortalidade Materna , Equipe de Assistência ao Paciente , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/terapia , Gravidez , Medição de Risco , Fatores de Risco , Adulto Jovem
5.
West Afr J Med ; 37(1): 74-78, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32030716

RESUMO

PURPOSE: Identification of health problems of women of reproductive age, using a reliable mortality data, is essential in evading preventable female deaths. This study aimed at investigating mortality profile of women of reproductive age group in Nigeria. MATERIALS AND METHODS: This is a descriptive, retrospective study involving women of reproductive age group of 15-49 years that died at DELSUTH from 1st January 2016 to 31st December 2018. The age, date of death and cause of death were retrieved from the hospital records and subsequently analyzed using SPSS version 21. RESULTS: One hundred and eighty-seven eligible deaths were encountered in this study, constituting 17.5% of all deaths in the hospital. Twenty four (12.8%) cases were of maternal etiology while 163 (87.2%) were of non-maternal causes. Non-communicable disease, communicable disease and external injuries accounted for 100 (53.5%), 44 (23.5%) and 19 (10.2%) deaths among the non-maternal causes. The mean age and the peak age group are 34.4 years and the 4th decade respectively. The leading specified non-maternal causes of death (in descending order) are AIDS/TB, cerebrovascular accidents (CVA), breast cancer, road traffic accident (RTA), diabetes, perioperative death and sepsis while the leading maternal causes of death are abortion, postpartum hemorrhage, eclampsia and puerperal sepsis. CONCLUSION: Most deaths affecting WRAG are preventable, with non-maternal causes in excess of maternal causes. There is need for holistic life-long interventional policies and strategies that will address the health need of these women, using evidence-based research findings.


Assuntos
Mortalidade Hospitalar , Hospitais/estatística & dados numéricos , Mortalidade Materna , Aborto Induzido/mortalidade , Adolescente , Adulto , Neoplasias da Mama/mortalidade , Causas de Morte/tendências , Eclampsia/mortalidade , Feminino , Infecções por HIV/mortalidade , Humanos , Mortalidade Materna/tendências , Pessoa de Meia-Idade , Nigéria/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Infecção Puerperal/mortalidade , Estudos Retrospectivos , Sepse/mortalidade , Acidente Vascular Cerebral , Tuberculose/mortalidade , Adulto Jovem
6.
BMC Pregnancy Childbirth ; 20(1): 130, 2020 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-32106814

RESUMO

BACKGROUND: In sub-Saharan Africa, maternal death due to direct obstetric complications remains an important health threat for women. A high direct obstetric case fatality rate indicates a poor quality of obstetric care. Therefore, this study was aimed at assessing the magnitude and determinants of the direct obstetric case fatality rate among women admitted to hospitals with direct maternal complications. METHODS: In 2015, the Ethiopian Public Health Institute conducted a national survey about emergency obstetric and newborn care in which data about maternal and neonatal health indicators were collected. Maternal health data from these large national dataset were analysed to address the objective of this study. Descriptive statistics were used to present hospital specific characteristics and the magnitude of direct obstetric case fatality rate. Logistic regression analysis was performed to examine determinants of the magnitude of direct obstetric case fatality rate and the degree of association was measured using an adjusted odds ratio with 95% confidence interval at p < 0.05. RESULTS: Overall, 335,054 deliveries were conducted at hospitals and 68,002 (20.3%) of these women experienced direct obstetric complications. Prolonged labour (23.4%) and hypertensive disorders (11.6%) were the two leading causes of obstetric complications. Among women who experienced direct obstetric complications, 435 died, resulting in the crude direct obstetric case fatality rate of 0.64% (95% CI: 0.58-0.70%). Hypertensive disorders (27.8%) and maternal haemorrhage (23.9%) were the two leading causes of maternal deaths. The direct obstetric case fatality rate varied considerably with the complications that occurred; highest in postpartum haemorrhage (2.88%) followed by ruptured uterus (2.71%). Considerable regional variations observed in the direct obstetric case fatality rate; ranged from 0.27% (95% CI: 0.20-0.37%) at Addis Ababa city to 3.82% (95% CI: 1.42-8.13%) at the Gambella region. Type of hospitals, managing authority and payment required for the service were significantly associated with the magnitude of direct obstetric case fatality rate. CONCLUSIONS: The high direct obstetric case fatality rate is an indication for poor quality of obstetric care. Considerable regional differences occurred with regard to the direct obstetric case fatality rate. Interventions should focus on quality improvement initiatives and equitable resource distribution to tackle the regional disparities.


Assuntos
Mortalidade Materna , Complicações do Trabalho de Parto/mortalidade , Causas de Morte , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Morte Materna/estatística & dados numéricos , Razão de Chances , Hemorragia Pós-Parto/mortalidade , Gravidez , Ruptura Uterina/mortalidade
7.
BMC Pregnancy Childbirth ; 20(1): 34, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931785

RESUMO

BACKGROUND: Postpartum hemorrhage (PPH) is the leading cause of maternal death in Tanzania. The Every Second Matters for Mothers and Babies- Uterine Balloon Tamponade (ESM-UBT) device was developed to address this problem in women with atonic uterus. The objective of this study was to understand the barriers and facilitators to optimal use of the device, in Dar es Salaam Tanzania 1 year after implementation. METHODS: Semi-structured interviews of skilled-birth attendants were conducted between May and July 2017. Interviews were recorded, coded and analyzed for emergent themes. RESULTS: Among the participants, overall there was a positive perception of the ESM-UBT device. More than half of participants reported the device was readily available and more than 1/3 described ease and success with initial use. Barriers included fear and lack of refresher training. Finally, participants expressed a need for training and device availability at peripheral hospitals. CONCLUSION: The implementation and progression to optimal use of the ESM-UBT device in Tanzania is quite complex. Ease of use and the prospect of saving a life/preserving fertility strongly promoted use while fear and lack of high-level buy-in hindered utilization of the device. A thorough understanding and investigation of these facilitators and barriers are required to increase uptake of the ESM-UBT device.


Assuntos
Preservativos Femininos , Serviços de Saúde Materna/estatística & dados numéricos , Hemorragia Pós-Parto/terapia , Tamponamento com Balão Uterino/instrumentação , Inércia Uterina/terapia , Adulto , Feminino , Implementação de Plano de Saúde , Acesso aos Serviços de Saúde , Humanos , Mortalidade Materna/tendências , Hemorragia Pós-Parto/mortalidade , Gravidez , Encaminhamento e Consulta , Tanzânia/epidemiologia , Tamponamento com Balão Uterino/mortalidade , Inércia Uterina/mortalidade
8.
Anesth Analg ; 130(1): 52-62, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31283618

RESUMO

BACKGROUND: The variability in resources for managing critical events among maternity hospitals may impact maternal safety. Our main objective was to assess the risk of postpartum maternal death according to hospitals' organizational characteristics. A secondary objective aimed to assess the specific risk of death due to postpartum hemorrhage (PPH). METHODS: This national population-based case-control study included all 2007-2009 postpartum maternal deaths from the national confidential enquiry (n = 147 cases) and a 2010 national representative sample of parturients (n = 14,639 controls). To adjust for referral bias, cases were classified by time when the condition/complication responsible for the death occurred: postpartum maternal deaths due to conditions present before delivery (n = 66) or during or after delivery (n = 81). Characteristics of delivery hospitals included 24/7 on-site availability of an anesthesiologist and an obstetrician, level of perinatal care, number of deliveries annually, and their teaching and profit status. In teaching and other nonprofit hospitals in France, obstetric care is organized on the principle of collective team-based management, while in for-profit hospitals, this organization is based mostly on that of "one woman-one doctor." Logistic regression models were used to estimate adjusted odds ratios (aORs) and 95% confidence intervals (CIs) for postpartum maternal death. RESULTS: The risk of maternal death from prepartum conditions was lower for women who gave birth in for-profit compared with teaching hospitals (aOR, 0.3; 95% CI, 0.1-0.8; P = .02) and in hospitals with <1500 vs ≥1500 annual deliveries (aOR, 0.4; 95% CI, 0.1-0.9; P = .02). Conversely, the risk of postpartum maternal death from complications occurring during or after delivery was higher for women who delivered in for-profit compared with teaching hospitals (aOR, 2.8; 95% CI, 1.3-6.0; P = .009), as was the risk of death from PPH in for-profit versus nonprofit hospitals (aOR, 2.8; 95% CI, 1.2-6.5; P = .019). CONCLUSIONS: After adjustment for the referral bias related to prepartum morbidity, the risk of postpartum maternal mortality in France differs according to the hospital's organizational characteristics.


Assuntos
Disparidades em Assistência à Saúde/tendências , Administração Hospitalar/tendências , Hospitais/tendências , Mortalidade Materna/tendências , Parto , Hemorragia Pós-Parto/mortalidade , Período Pós-Parto , Padrões de Prática Médica/tendências , Adulto , Estudos de Casos e Controles , Feminino , França/epidemiologia , Humanos , Hemorragia Pós-Parto/diagnóstico , Hemorragia Pós-Parto/terapia , Prognóstico , Medição de Risco , Fatores de Risco , Fatores de Tempo
9.
BMC Pregnancy Childbirth ; 19(1): 514, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864320

RESUMO

BACKGROUND: Paucity of data on state-wide maternal mortality in Nigeria hampers planning, monitoring and evaluation of the impact of interventions. The Confidential Enquiry into Maternal Deaths in Ondo State was initiated to overcome this problem. This study aimed to compare trends of maternal mortality ratios, causes of deaths, geographical distribution and other associated factors in 12-monthly reports of the Confidential Enquiry into Maternal Deaths in Ondo State. METHODS: Notification forms were distributed throughout the State to focal persons and medical records officers at community and facility levels, respectively. Maternal deaths, as defined in the International Classification of Diseases 10th version, were recorded prospectively over 3 years from 1st June 2012 to 30th May, 2015. Forms were submitted, collated and data analysed by a multidisciplinary review committee. RESULTS: Reported numbers of maternal deaths (and maternal mortality ratios) were 114 (253 per 100,000 births), 89 (192) and 81 (170), respectively per year, indicating a 33% reduction in maternal mortality ratio over the course of the study period. Assuming that the confidential enquiry process was the only intervention at the time aimed at reducing maternal mortality, simple linear regression with a correlation coefficient of 0.9314, showed a relationship though the difference in the values were not statistically significant (95% CI = - 184.55 to 101.55, p = 0.169). Postpartum haemorrhage and eclampsia were the leading causes of deaths. CONCLUSION: There was a trend of reduction in maternal mortality ratio during the period of study with postpartum haemorrhage as the major cause of death. The positive association between the confidential enquiry reports and maternal mortality ratios make us recommend that our model be adopted in other states and at the federal level.


Assuntos
Causas de Morte , Mortalidade Materna/tendências , Adolescente , Adulto , Eclampsia/mortalidade , Cura pela Fé , Feminino , Humanos , Modelos Lineares , Nascimento Vivo/epidemiologia , Tocologia , Nigéria/epidemiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Sepse/mortalidade , Ruptura Uterina/mortalidade , Adulto Jovem
10.
BMC Pregnancy Childbirth ; 19(1): 489, 2019 Dec 11.
Artigo em Inglês | MEDLINE | ID: mdl-31829139

RESUMO

BACKGROUND: Postpartum haemorrhage (PPH) is the leading direct cause of maternal morbidity and mortality worldwide. The sustainable development goals aim to reduce the maternal mortality ratio to 70 per 100,000 live births. In Namibia, the ratio was reported as 265 per 100,000 live births in 2015 and yet little is published on emergency obstetric care. The majority of deliveries in Namibia are facility-based. The aim of this study was to assess and improve the quality of care for women with PPH at Onandjokwe Hospital, Namibia. METHODS: A criterion-based audit cycle in all 82 women with PPH from 2015 using target standards for structure, process and outcomes of care. The audit team then planned and implemented interventions to improve the quality of care over a 10-month period. The audit team repeated the audit on all 70 women with PPH from the same 10-month period. The researchers compared audit results in terms of the number of target standards achieved and any significant change in the proportion of patients' care meeting the predetermined criteria. RESULTS: In the baseline audit 12/19 structural, 0/9 process and 0/3 outcome target standards were achieved. On follow up 19/19 structural, 6/9 process and 2/3 outcome target standards were met. There was one maternal death in the baseline group and none in the follow up group. Overall 6/9 process and 2/3 outcome criteria significantly improved (p <  0.05) from baseline to follow up. Key interventions included training of nursing and medical staff in obstetric emergencies, ensuring that guidelines and standard operating protocols were easily available, reorganising care to ensure adequate monitoring of women postpartum and ensuring that essential equipment was available and functioning. CONCLUSION: The study demonstrates that the quality of care for emergency obstetrics can be improved by audit cycles that focus on the structure and process of care. Other hospitals in Namibia and the region could adopt the process of continuous quality improvement and similar strategies.


Assuntos
Parto Obstétrico/normas , Serviços Médicos de Emergência/normas , Cuidado Pós-Natal/normas , Hemorragia Pós-Parto/terapia , Melhoria de Qualidade/organização & administração , Adulto , Auditoria Clínica/métodos , Auditoria Clínica/organização & administração , Parto Obstétrico/métodos , Serviços Médicos de Emergência/métodos , Feminino , Seguimentos , Humanos , Namíbia/epidemiologia , Avaliação de Processos e Resultados em Cuidados de Saúde , Cuidado Pós-Natal/métodos , Cuidado Pós-Natal/organização & administração , Hemorragia Pós-Parto/mortalidade , Gravidez , Garantia da Qualidade dos Cuidados de Saúde , Estudos Retrospectivos
11.
J Fam Pract ; 68(9): E12-E13, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31725142

RESUMO

When used in conjunction with the standard of care, 1 g intravenous (IV) tranexamic acid given 1 to 3 hours after delivery is associated with a significant reduction in maternal mortality from postpartum hemorrhage (PPH) (strength of recommendation: A, randomized controlled trial [RCT] and Cochrane review).


Assuntos
Antifibrinolíticos/uso terapêutico , Hemorragia Pós-Parto/tratamento farmacológico , Hemorragia Pós-Parto/mortalidade , Ácido Tranexâmico/uso terapêutico , Feminino , Humanos , Injeções Intravenosas , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Resultado do Tratamento
12.
PLoS One ; 14(10): e0208367, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31600195

RESUMO

BACKGROUND: Postpartum hemorrhage (PPH) is a leading cause of maternal mortality in Nigeria and in most low- and middle-income countries. The World Health Organization (WHO) strongly recommends oxytocin as effective, affordable, and the safest drug of first choice in the prevention and treatment of PPH in the third stage of labor. However, there are concerns about its quality. Very high prevalence of poor-quality oxytocin, especially in Africa and Asia, has been reported in literature. Excessive and inappropriate use of oxytocin is also common in low-resource settings. OBJECTIVE: To assess clinical experiences with quality of oxytocin used by healthcare providers in Lagos State, Nigeria. METHODS: This was a descriptive cross-sectional study conducted in 2017, with 705 respondents (doctors and nurses) who use oxytocin for obstetrics and gynecological services recruited from 195 health facilities (public and registered private) across Lagos State. Data collection was quantitative, using a pretested self-administered questionnaire. Data analysis was performed with IBM SPSS version 21. Statistical significance was set at 5 percent (p<0.05). Ethical approval was obtained from Lagos University Teaching Hospital Health Research Ethics Committee. RESULTS: Only 52 percent of the respondents knew oxytocin should be stored at 2°C to 8°C. About 80 percent of respondents used oxytocin for augmentation of labor, 68 percent for induction of labor, 51 percent for stimulation of labor, and 78 percent for management of PPH. Forty-one percent used 20IU and as much as 10% used 30IU to 60IU for management of PPH. About 13 percent of respondents reported believing they had used an ineffective brand of oxytocin in their practice. Just over a third (36%) had an available means of documenting or reporting perceived ineffectiveness of drugs in their facility; of these, only about 12 percent had pharmacovigilance forms in their facilities to report the ineffectiveness. CONCLUSION: The inappropriate and inconsistent use of oxytocin, especially overdosing, likely led to the high perception of medicine effectiveness among respondents. This is coupled with lack of suspicion of medicine ineffectiveness by clinicians as a possible root cause of poor treatment response or disease progression. Poor knowledge of oxytocin storage and consequent poor storage practices could have contributed to the ineffectiveness reported by some respondents. It is necessary to establish a unified protocol for oxytocin use that is strictly complied with. Continuous training of healthcare providers in medicine safety monitoring is advocated.


Assuntos
Pessoal de Saúde , Hospitais de Ensino , Mortalidade Materna , Ocitocina/administração & dosagem , Hemorragia Pós-Parto , Inquéritos e Questionários , Adulto , Estudos Transversais , Feminino , Humanos , Trabalho de Parto , Masculino , Nigéria/epidemiologia , Hemorragia Pós-Parto/tratamento farmacológico , Hemorragia Pós-Parto/mortalidade , Gravidez , Prevalência
13.
Rev Colomb Obstet Ginecol ; 70(1): 8-18, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-31613066

RESUMO

OBJETIVE: To identify the causes of maternal mor- tality in the Callao Region between 2000 and 2015. METHODS: Case series study conducted in public and private healthcare institutions in the region of Callao in Perú. Overall, 131 women who met the selection criteria were included as cases of maternal mortality (MM). MM was defined as death of a woman during pregnancy, childbirth or the postpartum period (within the first 42 days after childbirth) in healthcare institutions in Callao. MM clinical-epidemiological records were reviewed. The analysis was performed using percent frequencies and means. RESULTS: Of the causes of MM, 61.1 % were direct and 38.9 % were indirect. The most frequent direct causes were hypertensive disorders of pregnancy, obstetric bleeding and miscarriage. Average time between the onset of discomfort and the decision to ask for assistance was 20 minutes; mean time to arrive at the healthcare institution after making the decision was 20 minutes; and mean delay time between arrival to the institution and provision of care was 7 minutes. Of the total number of maternal deaths, 96.9 % occurred in a healthcare institution. CONCLUSION: The study showed that the causes of MM are mainly of a direct type, primarily due to hypertensive disorders of pregnancy, obstetric bleeding and miscarriage, while indirect causes of MM were less frequent, consisting mainly of infectious causes..


Assuntos
Causas de Morte , Morte Materna/estatística & dados numéricos , Mortalidade Materna , Complicações na Gravidez/mortalidade , Aborto Espontâneo/epidemiologia , Aborto Espontâneo/mortalidade , Adolescente , Adulto , Feminino , Humanos , Peru/epidemiologia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/epidemiologia , Tempo para o Tratamento , Adulto Jovem
14.
Lakartidningen ; 1162019 Sep 27.
Artigo em Sueco | MEDLINE | ID: mdl-31573669

RESUMO

MM-ARG, the Swedish maternal maternity mortality group within SFOG (Swedish Society of Obstetrics and Gynecology) has, since 2008, surveyed and analysed maternal deaths in Sweden with the aim to find and give feedback on lessons learned to the medical professions.  MM-ARG consists of obstetricians, midwives and anesthetists and the strength of the working model is that the profession itself takes responsibility for the scrutiny.  A summary of 67 known maternal deaths from 2007‒2017 is presented. Direct causes of death are dominated by hypertensive disease/preeclampsia, followed by thromboembolic disease, sepsis and obstetric bleeding. Indirect death, where a known or unknown underlying disease is exacerbated by pregnancy, is dominated by cardiovascular disease. This review shows that the diagnostics and clinical management could be improved. Besides obstetrics/gynecology, maternal mortality affects other specialties and thus holds important lessons to many.


Assuntos
Mortalidade Materna , Adolescente , Adulto , Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Feminino , Humanos , Morte Materna , Transtornos Mentais/mortalidade , Transtornos Mentais/prevenção & controle , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/prevenção & controle , Pré-Eclâmpsia/mortalidade , Pré-Eclâmpsia/prevenção & controle , Gravidez , Complicações na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/mortalidade , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Neoplásicas na Gravidez/mortalidade , Complicações Neoplásicas na Gravidez/prevenção & controle , Qualidade da Assistência à Saúde , Sociedades Médicas , Suicídio/prevenção & controle , Suécia/epidemiologia , Tromboembolia/mortalidade , Tromboembolia/prevenção & controle
15.
BMC Pregnancy Childbirth ; 19(1): 379, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651264

RESUMO

BACKGROUND: Niger has one of the highest maternal mortality ratios in Sub Saharan Africa, of which postpartum hemorrhage is the leading cause. In 2014, Health and Development International and the Ministry of Health of Niger launched an initiative to introduce and scale-up three PPH interventions in health facilities nationwide: misoprostol, uterine balloon tamponade, and the non-pneumatic anti-shock garment. METHODS: A two-phase mixed-methods evaluation was conducted to assess implementation of the initiative. Health facility assessments, provider interviews, and household surveys were conducted in May 2016 and November 2017. RESULTS: All evaluation facilities received misoprostol prevention doses. However, shortages in misoprostol treatment doses, UBT kits, and NASG stock were documented. Health provider training increased while knowledge of each PPH intervention varied. Near-universal uterotonic coverage for PPH prevention and treatment was achieved and sustained throughout the evaluation period. Use of UBT and NASG to manage PPH was rare and differed by health facility type. Among community deliveries, fewer than 22% of women received misoprostol at antenatal care for self-administered prophylaxis. Among those who did, almost all reported taking the drugs for PPH prevention in each phase. CONCLUSIONS: This study is the first external evaluation of a comprehensive PPH program taking misoprostol, UBT, and NASG to national scale in a low resource setting. Although gaps in service delivery were identified, results demonstrate the complexities of training, managing stock, and implementing system-wide interventions to reach women in varying contexts. The experience provides important lessons for other countries as they develop and expand evidence-based programs for PPH care.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Implementação de Plano de Saúde/estatística & dados numéricos , Programas Nacionais de Saúde/estatística & dados numéricos , Hemorragia Pós-Parto/prevenção & controle , Adulto , Feminino , Trajes Gravitacionais/estatística & dados numéricos , Humanos , Misoprostol/uso terapêutico , Níger/epidemiologia , Ocitócicos/uso terapêutico , Hemorragia Pós-Parto/mortalidade , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Tamponamento com Balão Uterino/estatística & dados numéricos
17.
Afr J Reprod Health ; 23(2): 18-26, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31433590

RESUMO

On average 16%-53% of maternal deaths are from postpartum haemorrhage (PPH), with confidence intervals for Eastern Asia reaching beyond 60%. Success in preventing PPH mortality across many large low-resource populations has been fairly limited. Niger's government and an international non-governmental organization (NGO) have developed a model aiming to rapidly reduce primary postpartum haemorrhage mortality, combining relatively new technologies, misoprostol, condom tamponade, and non- inflatable anti-shock garment, with systematic measurement of blood loss and a set of traditional public health tools that constitute the Catalyst Approach to Public Health, with action steps for each phase if haemorrhage occurs. This paper describes each component and testing of the hypothesis that the model can effectively reduce PPH mortality on a national scale. The Niger model is a 'complex intervention' aiming to maximise impact from existing health system resources even in remote areas. The broad applicability of Niger's approach to address a serious global public health problem, and its innovative nature warrant describing the model itself, with results to be published separately. Combining this set of individually proven technologies and a set of organisational tools from disease eradication settings as a single 'complex intervention', has to our knowledge not been described before.


Assuntos
Morte Materna/estatística & dados numéricos , Mortalidade Materna , Misoprostol/uso terapêutico , Ocitócicos/uso terapêutico , Hemorragia Pós-Parto/prevenção & controle , Feminino , Serviços de Saúde , Humanos , Morte Materna/etiologia , Níger , Hemorragia Pós-Parto/mortalidade , Gravidez , Saúde Pública
18.
Sci Rep ; 9(1): 11026, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31363105

RESUMO

This descriptive study was based on the maternal death registration system established by the Japan Association of Obstetricians and Gynecologists and the Maternal Death Exploratory Committee (JMDEC). 361 women died during pregnancy or within 42 days after delivery between January 2010 and June 2017 throughout Japan were analysed, in order to investigate the trend in maternal deaths related to obstetric medical practice. Reports of maternal death were consistent, ranging from 45 cases in 2010 to 44 cases in 2017. Among all maternal deaths, the frequency of deaths due to obstetric haemorrhage ranged from 29% (2010) to 7% (2017) (p < 0.001). The causes of obstetric haemorrhage have progressively reduced, especially maternal deaths due to uterine inversion and laceration have not occurred since 2014. The remaining causes of obstetric haemorrhage-related maternal deaths were placenta accreta spectrum, placental abruption, and severe forms of uterine focused amniotic fluid embolism. We believe the activities of the JMDEC including annual recommendations and simulation programs are improving the medical practices of obstetric care providers in Japan, resulting in a reduction of maternal deaths due to obstetric haemorrhage.


Assuntos
Morte Materna/estatística & dados numéricos , Hemorragia Pós-Parto/epidemiologia , Adulto , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Japão , Pessoa de Meia-Idade , Doenças Placentárias/epidemiologia , Hemorragia Pós-Parto/mortalidade , Gravidez
19.
Rev. cuba. anestesiol. reanim ; 18(2): e245, mayo.-ago. 2019. tab
Artigo em Espanhol | LILACS, CUMED | ID: biblio-1093103

RESUMO

Introducción: La hemorragia posparto es una de las principales causas de mortalidad materna. Objetivo: Caracterizar la hemorragia posparto. Métodos: Se realizó un estudio descriptivo, longitudinal y prospectivo en el servicio de Anestesiología y Reanimación del Hospital Dr. Agostinho Neto entre los años 2015-2017. El universo se constituyó por 65 pacientes. Se estudiaron las siguientes variables: edad biológica, edad gestacional, tipo de hemorragia, cantidad estimada del sangrado, etiología, variables de laboratorio clínico y hemodinámicas, reanimación con fluidos y hemoderivados, complicaciones. Se emplearon métodos empíricos (análisis documental, instrumentos para la recolección de la información), teóricos (procedimientos de análisis, síntesis, inducción, deducción) y matemático-estadístico (porcentaje, media, la desviación típica e intervalos de confianza). Resultados: La edad media de las pacientes fue de 24,2 ± 6,2 años; la edad gestacional fue de 34,2 ± 6,2 años; 73,8 por ciento terminó el embarazo por vía vaginal e intervalo entre el parto, el inicio de la hemorragia posparto fue de 2,46 h ± 53 min. La atonía uterina (61,5 por ciento) fue la causa más común de la hemorragia. El shock fue la complicación más común (100 por ciento), lo que condicionó el uso de altos volúmenes de fluidos y hemoderivados para su reanimación. La histerectomía y ligadura arterias hipogástricas fue la técnica quirúrgica más utilizada (52,3 por ciento). Conclusiones: La hemorragia posparto fue una causa importante de morbilidad y mortalidad en el mencionado servicio de salud(AU)


Introduction: Postpartum hemorrhage is one of the main causes of maternal mortality. Objective: To characterize postpartum hemorrhage. Methods: A descriptive, longitudinal and prospective study was carried out in the Anesthesiology and Resuscitation service of Dr. Agostinho Neto Hospital, between 2015 and 2017. The study population was made up by 65 patients. The following variables were studied: biological age, gestational age, type of hemorrhage, estimated amount of bleeding, etiology, hemodynamic and clinical laboratory variables, fluid resuscitation and blood products replacement, complications. We used empirical methods (document analysis, instruments for the collection of information), theoretical methods (analysis, synthesis, induction, deduction), and mathematical-statistical methods (percentage, mean, standard deviation and confidence intervals). Results: The average age of the patients was 24.2±6.2 years; the gestational age was 34.2±6.2 years; 73.8 percent completed the pregnancy by natural delivery, while the interval between delivery and the onset of postpartum hemorrhage was 2.46h±53 min. Uterine atony (61.5 percent) was the most common cause of hemorrhage. Shock was the most common complication (100 percent), which conditioned the use of high volumes of replacement fluids and blood products. Hysterectomy and ligation of hypogastric arteries was the most used surgical technique (52.3 percent). Conclusions: During the study period, postpartum hemorrhage was an important cause of morbidity and mortality in the Anesthesiology and Resuscitation service of Dr. Agostinho Neto Hospital(AU)


Assuntos
Complicações na Gravidez/mortalidade , Período Pós-Parto , Hemorragia Pós-Parto/mortalidade , Hemorragia Pós-Parto/epidemiologia , Anestesiologia , Epidemiologia Descritiva , Estudos Prospectivos , Estudos Longitudinais
20.
Transfus Apher Sci ; 58(4): 412-415, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31285133

RESUMO

Patient blood management (PBM) aims to reduce red blood cell transfusion, minimize preoperative anemia, reduce intraoperative blood loss as well as optimize hemostasis, and individually manage postoperative anemia. Benefits include improved clinical outcome with a reduction in patient morbidity and mortality, but also lower hospital costs and shorter hospital length of stay. To date, it has been successfully implemented in several medical specialties, such as cardiac, trauma and orthopedic surgery. In obstetrics, postpartum hemorrhage (PPH) is one of the leading causes of maternal mortality. PBM has the potential to improve outcome of mother and child. However, pregnancy and childbirth pose a special challenge to PBM, and several adaptations compared to PBM in elective surgery are necessary. To date, awareness of the clinical advantages of PBM among obstetricians and midwifes regarding PBM and its concept in PPH is limited. In the following review, we therefore aim to present the current status quo in PBM in obstetrics and its challenges in the clinical routine.


Assuntos
Perda Sanguínea Cirúrgica/prevenção & controle , Parto Obstétrico , Procedimentos Cirúrgicos Eletivos , Hemostasia , Hemorragia Pós-Parto/terapia , Perda Sanguínea Cirúrgica/mortalidade , Feminino , Humanos , Mortalidade Materna , Hemorragia Pós-Parto/mortalidade
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